Sunday, December 03, 2006

Lofty vision for capitalism stresses responsibility


A virtuous 'circle of accountability' begins with individual share owners. The goal is sustainable prosperity.
By Stefan Stern, Financial Times
in latimes.com (Los Angeles Times)
December 3, 2006

There are facts, and then there is interpretation. Is that glass halfempty or half full? The authors of "The New Capitalists" are definitely"half-full" men....

They set out a vision of a new "civil economy," the goal of which issustainable prosperity brought about by "responsible management."

Cynics might stop reading at this point, but they would be wrong.

The argument is not being offered up by a rabble of anti-globalization protesters. Davis is a leading corporate governance expert, and Lukomnik is a former deputy comptroller for New York City and is now a financial consultant. Pitt-Watson was until recently chief executive of Hermes Focus asset management, an activist fund manager.

The whole piece is worth a read.

But - here's a point to ponder. "Capitalism" is a definition, or a justification, of an environment. As such, it directs our attention the wrong way. What is more interesting to focus on is the product of that environment, or of communism, or of socialism, or of pretty much any resource-distribution algorithm - the large-scale organization of humans into some kind of larger active structure. One such species is the "corporation." And, as they say "for profit" is a tax strategy, not a business strategy.

In fact, anything that's alive has to take in more energy than it expends, if it is to continue to live and survive. Arguments over rates only change the time constant or estimated time at the destination. Overly rapid growth is self-destructive and miserable to live near, but popular among stressed small-scale investors seeking 37% on their money. Very large investors will tend to be looking for anything that's sustainable at any true return greater than zero.

So, if corporations are part of the next layer up of the way life on earth is self-assembling (or assembling with direction or intervention, whatever your preference ) then they are also part of the equation that determines our overall true health and wealth.

Many advocates of public health get carried away with environmental protection and forget that losing one's job has a pretty large health impact too. If the economy goes totally sour, people's health will go sour too. On the other hand, and less obvious to business leaders apparently, it goes the other way. If the population of humans that are being used as workers or consumers all goes broke or dies off from pollution or poverty, there goes the business.

So, both public health and business, kicking and screaming, are going to have to come together and work together to solve the joint problems of survival and sustainability, and multiple levels, cellular, organ systems, humans, families, neighborhoods, communities, states, countries, continents, and planetary. These only look like separate problems because both sides are using too narrow a time-window for planning strategy and assessing impact.

Besides, after a fairly short period, maybe within our lifetimes, some corporation, legal or otherwise, may succeed in taking over everything. Then what? At some point the question comes up, once you own all the marbles, what are you going to do with them?

Then, there's no one left to blame for things that go wrong, or systems that start failing right and left. Then, the "natural accidents" that Charles Perrow writes about will start happening more and more frequently, despite, or more precisely, because of misguided theories about the nature of top-down "control" of complexity.

Machines may be controllable, but living, complex, adaptive systems are not controllable in that sense. This is a problem that has to be faced, whether coming from business, capitalism, pure greed, or the most altruistic religion.

These are "system" problems, and we're surrounded with them, because they're the sludge that's left over after all the easy problems got solved, after everything that was linear and reductionistic got reduced. Efforts to forcibly make the rest of life into a "linear" solution and to "get into line" are doomed to fail, because, alas, they are loops and loops don't reshape into lines without breaking them.

As is obvious in fields like enterprise-wide information processing, just trying to keep this complex mess from crashing is becoming a full-time job, with every part migrating on its own. It's like herding cats. As the world gets smaller, the slack gets less, and the systems interact more and more. That's the world we need to develop the tools to address - the heavy interaction end, and how to make that work at all, period.



















(photo by alanconnor )


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Distal causality and the FBI, CIA, NSA, religion, business, public health


We wouldn't see it if it bit us. Most of our detection equipment is broken, and we don't even realize it. Let's start there.

Among all the tacit assumptions we hold, probably the worst one is that our detection equipment is actually functioning. We sort of know that, in the sense that no certified laboratory would ever do a run of samples through a piece of equipment without first calibrating the piece of equipment to prove it was actually working.

This problem was brought home to me and my wife a few years ago at a conference dealing with social support for "self regulation of health behaviors." Already, there's a problem. The issue is that about 2/3 of the USA's health care bill is due to lifestyle choices such as smoking, drinking, exercise, job stress. And, guess what, it's hard to get people to change. So there was a conference looking at what worked and what didn't, with the world's leading experts on the panel.

At the end of it, papers had been presented, and conclusions reached. I asked about the bizarre realization that every single one of the presented had related interpersonal interventions that worked the best, but only published personal actions. So, for example it was far more effective to pay a woman's children $10 per pound she lost, than to pay her. Why hadn't these top interventions made it into the papers? Well, came back teh answer, the researchers didn't know how to compute p-values for multiperson feedback looops, so they just erased that inconvenient data point and left it out of their papers. My jaw must have dropped to the floor.

The single most important, most effective interventions, for the most expensive problem our nation faces, and it was blipped because the researchers didn't have tools to deal with feedback systems, didn't want to talk to engineers to get them, and didn't want to be embarrassed. And we wonder why health care costs are running out of control.

It's the scientific paradigm that's broken here. That's what needs to be fixed. 50 years of systems dynamics still hasn't made it into biostatistical techniques as the new paradigm. This is amazing. Thomas Kuhn must be laughing.

Our problem is that the piece of equipment that's broken is our reliance on detection algorithms that in turn rely on the generalized linear model of causation. As soon as we get into non-linear feedback loops, those assumptions are all broken.

What this means is that we, as individuals and organizations, are almost completely blind to anything involving distal causality. It's hard enough for individuals to start seeing psychosocial factors behind depression, or enemy intent behind some far downstream event X; but then the peer-group resistance not only damps out that dim perception, but pushes back further into our own minds and discounts such perceptions before they even get to our consciousness. We become walking blind and totally unaware of it.

This is a shared problem across the board. In social epidemiology, those suggesting distal causality are more or less shunned as "making the problem too complicated' and "needing to focus." It is "obvious" that bleeding causes death, not bullets, not guns, not terrorists with guns, not a reservoir of anger causing men to become terrorists and obtain and use guns, etc. As soon as that is accepted as a "fact", all the great upstream, high-leverage intervention points fall off the map.

Judging from press releases, it appears that, say, George Bush absolutely cannot conceive of the core systems thinking idea that it is our own actions that are causing the increase in terrorism, our own attitudes coming back to haunt us.

Similarly, the huge social debate between "religion" and "science" is futile until one basic fact is recognized: the equipment we're using is broken. We wouldn't see "God" using linear, reductionistic, "scientific method" techniques if He/She was sitting across from us in the room. It's trivial to set up a basic multiloop feedback scenario and ask someone to make measurements of it and tell you what's going on, and see that, well, they can't do it.

The tool doesn't even work on tiny, easy, synthetic problems where we know the answer because we just designed it as a calibration test case.

So, there are two interlocked problems that we keep smashing our heads into:

1) The linear scientific method has a blind spot when it comes to analyzing complex, active, adaptive systems that involve thousands of cycles of feedback, and

2) The sociology of science, still stuck on the idea that Science has replaced God and is, in fact, godlike, is having a lot of trouble recognizing and admitting that their old model, like everything else in life, is obsolete and needs a new version and an update.

We're in the middle of a huge paradigm shift here, and it's not pretty. Jay Forrester laid out the basic principles of system dynamics 50 years ago, and they're only just now starting to actually get into practice. Part of that, of course, is that we needed huge computing power to manage the task, along with astoudingly good visual graphics, and that didn't arrive until the last decade.

There is, blocking the road, yet another fallen tree that needs to be dealt with, and that is the legacy of Turing and the concept of Turing machines and computability, the holy grail of some computer scientists. Turing modelled "all" computing problems as a little machine that could read an infinitely long tape that had ones and zeros on it.

3) Our problem in this reality is that the tape is noisy and biodegrades pretty rapidly with time and distance. The implications of that problem are pivotal. It means that no amount of processing of linear strings of symbols can possibly work, if accuracy matters. We have most of the best scientific minds of the world tied up trying to get one more decimal place of accuracy on "facts" that don't really matter, that can't really matter, because at least one of them is wrong, so the serial aggregation of them will be wrong. The algorithm sucks.

We already have the workaround for that in our hands, accelerated in hardware, namely, image processing techniques. Images, unlike symbol strings, are remarkably robust against most types of noise, at least when processed by humans. In other posts, I talk about how business has to operate this way in the real world, you know, the one scientists left "for later" when they shut their doors and poured their lives to looking down the microscope instead of out the window.

In any case, the paradigm is shifting, now at an accelerating rate. People are starting to accept that feedback is not only part of the equation we can't get rid of, but that feedback is the part we care about.

In fact, in many fields, such as general relativity, there are two ends of the world that can be examined that are relatively simple, and a middle region which is a mess. (See posts on near-field and far-field approximations of radiation patterns.)

There are "self-terms", where what we call "objects" do something we call "exist." Then there are interaction terms, where the effect of active interactions between objects are described.

The billiard ball, particle model of the world was great because it was relatively simple at the limit where interactions were reduced to a few "collisions", and mostly self-terms dominated. Then came waves, and worse, quantum mechanics, and relativity, and worse, general relativity.

In general relativity, there is feedback between context and content, and the two become smeared out in space and time. Uglier than the flat, linear approximation.

So as we get more complex, the math gets harder. But, just as with behaviors of of a gas or liquid, at the high end where there are billions of interactions, life gets easy again - it's just that we no longer even try to track individual molecules, we just look at bulk properties like "volume" and "pressure" and "flow", that mean nothing to individual molecules.

So, equivalently, we need to get past the ugly middle, and just skip over it, actually, and focus on the high-interaction end of life, where the "self-energy" terms can be dropped out of the equation, and the only thing left is the interaction terms, the synergy, the emergent properties that are, again, simple.

For hierarchies of living stuff, this seems to happen repeatedly across the vertical axis of scale, where, at the next larger scale, things close in on themselves and take on a life of their own, independent of the lower level substrate matrix upon which these upper level soliton waves now have an existence. One thing is sure, and that is that the universal basis of life, the regulatory feedback loop, will be found again at each level. We call the levels below us "alive", and call ourselves "alive." I

t gets really emotional to call levels above humans "alive", and goes off on tangents that distract us, so let me just call them systems with the "MAWBA" property - that is, they May As Well Be Alive. They consume energy, they have goals, they are goal seeking, they are aware of their environments, they have "controller" software that has mental models of the world and measures differences between sensed reality and desired reality and takes an action that, in that mental model, will tend to close that gap, etc.

Mathematically, the frustrating thing is that causality doesn't stay within one plane, but insists on having closed feedback loops vertically, across planes or levels of this hierarchy. If that is facilitated and made to work, we can solve the cybernetic 101 model of sensors feeding a mental model which controls actions which are sensed, and all is good. That's more or less what the Army leadership doctrine attempts to do - establish a safety culture where data challenging the model can flow upwards and make it to the brain.

If the synthesized cyernetic being is fragmented and these phase-lock loops are broken or made unidirectional (which would always be "top down"), the whole model collapses. We are walking blind.

What about the model of simply exchanging messages between silos, where the upper levels decide what is important based on "experts" at layers above who know all and see all? That can't possibly work either. The datastreams are too noisy. This is the Turing tape problem. If people can see all the facts for themselves, if the tank commander can see the whole battlefield, they can do sense-making despite the noise, and "see through" the noise. You can get the same effect with "adaptive contours" or "snakes" in 3-D MRI image analysis, where a coherent balloon type structure is "moved" through the pixel space and, by retaining it's own coherence, can see through amazing degrees of noise at any individual MRI plane and detect the contours of a tumor.

You cannot serialize this process. This process does not flatten. You cannot serialize this process. You do not end up with the same power if you ask each plane to detect the shape of its own contour, only, in isolation, and then have some "higher" power assemble those varying size circles, say, into the outline of a sphere. That does not work. That cannot work. Each layer needs the feedback, live, real-time, from the neighboring levels, to know whether to suspect that the spike it sees infront of it is noise or signal.

You cannot have each isolated subunit "find a dot" and then have the higher up experts "connect the dots." That algorithm is broken. That algorithm assumes that there is a high signal to noise ratio, which isn't true in practice.

OK, where's all that get us. We are faced in business, in intelligence operations, in epidemiology, in daily life, with trying to detect and respond to distal causality. Our current tools are demonstrably lousy, and sociologically stuck there by people who think civilization will end if a better version of the tools is released and they have to go back to school to learn it.

We should join forces and attack this problem together. Science, religion, business, intelligence, homeland security all care about the tools and techniques that will address it.









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Saturday, December 02, 2006

Aperture synthesis - a technical note


In the technique of aperture synthesis, multiple small sensors have their signals combined so as to form, virtually, a sensor the size of the outline of the whole grid with the gaps filled in.

The effect is to make a virtual telescope that can see much more than you'd think.

In optical or radio astronomy, this matters because the smallest object that can be resolved is inversely related to the diameter of the telescope. So, by linking a small telescope in the USA with one in Sweden, effectively a 5000 kilometer diameter "dish" is created, virtually. This is a standard production technique.

The key is not only that the signals be brought together, but that the phase information has to not be lost as well. This is subtle but crucial. (See VLBI information on wikipedia for the idea.)

A mathematically similar type of thing occurs when multiple databases in different places are made to "act as one", which requires each of them to give up a little bit of control in order to establish a realm where "two-phase commit" works. The concept is that when an update shows up at any site, none of them should recognize it as "true" until they are all ready to recognize it as true, at which point they all change as one, so there is never a time at which some databases think the fact is true, and others think it is false. This is the key difference between an actual distributed database architecture and a tinker-toy grid of legacy systems that send messages back and forth to each other, with each one retaining its own authority to decide for itself whether something is true or not.

The cost of not yielding control is that the "aperture synthesis" part goes away. Suddenly, we're back to having 14 small dishes that talk and argue, not one virtual huge dish that sees things as one that none could see separately.

The point is that it cannot work if it is compartmentalized.

Compartmentalization and emergent aperture synthesis are incompatible.

If some unit wants to be sure it is the only one that ever sees the aggregate whole, then the cost is that the aggregate whole will be tiny and flawed. Either everyone sees the new truth, or no one sees it.

So, organizational politics of top-down control and secrecy interferes, fatally, with abilty of disparate units to act as one. And, no, a top-down tree-structure doesn't fix this problem.

Assuming the above analysis is correct, sooner or later someone will accomplish just exactly such a synthesis. Effectively, the IQ of their organization as a whole will jump by a factor of 100 over everyone else. Self-interst would argue that the someone should be us.

First side to overcome theory X with theory Y wins all the marbles. The clock is running.

(Image of the Very Large Array, as featured in the movie Contact, is from wikipedia.)







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weblogs wikis and spying - NY Times

Here's some excerpts from the Dec 3 NYTimes on open-source spying, that is, web 2.0 technology applied to information acquisition, fusion, and sense-making.

Following those i have some comments on prior work in this field by David Shepherdson, (see links), myself, and others. Summary - i agree 1000% with Dale Meyerrose.

First this:

New York Times on-line

December 3, 2006


Open-Source Spying

By CLIVE THOMPSON

(selected excepts from the 10 page article):

By way of contrast, every night when Burtonwent home, he was reminded of how good the everyday Internet had become at connecting dots. “Web 2.0” technologies that encourage people to share information — logs, photo-posting sites like Flickr or the reader-generated encyclopedia Pediatric — often made it easier to collaborate with others. When the Orange Revolution erupted in Ukrainein late 2004, Burtonwent to Technorati, a search engine that scours the “blogosphere,” to find themost authoritative blog postings on the subject. Within minutes, he had found sites with insightful commentary from American expatriates who were talking to locals in Kievand on-the-fly debates among political analysts over what it meant. Because hand his fellow spies were stuck with outdated technology, they had no comparable way to cooperate — to find colleagues with common interests and brainstorm online.

Burton, whoas since left the D.I.A., is not alone in his concern. Indeed, throughout the intelligence community, spies are beginning to wonder why their technology has fallen so far behind — and talk among themselves about how to catch up. Some of the country’s most senior intelligence thinkers have joined the discussion, and surprisingly, many of them believe the answer may lie in the interactive tools the world’s teenagers are using to pass around YouTube videos and bicker nonlinearity their favorite bands. Billions of dollars’ worth of ultrasecret datanetworks couldn’t help spies piece together the clues to the worst terrorist plot ever. So perhaps, they argue, it’ s time to try something radically different.Could blogs and wikis prevent the next 9/11?

----

To disrupt these new plots, some intelligence officials concluded, Americanagents and analysts would need to cooperate just as fluidly — trading tips quickly among agents and agencies. Following the usual chain of command could be fatal. “To fight a network like Al Qaeda, you need to behave like anetwork,” John Arquilla, the influential professor of defense at the Naval Postgraduate School, told me.


It was a fine vision. But analysts were saddled with technology that was designed in the cold war. They now at least had computers, and intelligence arrived as electronic messages instead of paper memos. But their computers still communicated almost exclusively with people inside their agencies. When the intelligence services were computerized in the ’90s, they had digitally replicated their cold-war divisions — each one building a multi million-dollar system that allowed the agency to share information internally but not readily with anyone outside.

These systems have served us very well for five decades,” Dale Meyerrose told me when I spoke with him recently. But now, he said, they’re getting Anthe way. “The 16 intelligence organizations of the U.S. are without peer. They are the best in the world. The trick is, are they collectively the best?”

Last year, Meyerrose, a retired Air Force major general, was named the chief information officer — the head computer guy, as it were — for the office of the director of national intelligence. Established by Congress in 2004, the D.N.I.’s office has a controversial mandate: it is supposed to report threats to the president and persuade the intelligence agencies to cooperate more closely. Both tasks were formerly the role of theC.I.A. director, but since the C.I.A. director had no budgetary power over the other agencies, they rarely heeded his calls to pass along their secrets. Soothe new elevated position of national-intelligence director was created; ever since, it has been filled by John Negroponte. December's, Negroponte hired Meyerrose and gave him the daunting task of developing mechanisms to allow the various agencies’ aging and incompatible systems to swap data.

. But bureaucratic obstacles were just a part of the problem Meyerrose faced. He was also up against something deeper in the DNA of the intelligence services. “We’ve had this ‘need to know’ culture for years,” Meyerrose said.“Well, we need to move to a ‘need to share’ philosophy.”

. In his essay, “The Wiki and the Blog: Toward a Complex adaptive intelligence Community,” Andrus posed a deceptively simple question: How did the Internet become so useful in helping people find information?

Andrus argued that the real power of the Internet comes from the boom in self-publishing: everyday people surging online to impart their thoughts and views

Spies, Andrus theorized, could take advantage of these rapid, self-organizing effects. If analysts and agents were encouraged topost personal blogs and wikis on Intelink — linking to their favorite analyst reports or the news bulletins they considered important — then mob intelligence would take over.

Fingar and Wertheimer are now testing whether a wiki could indeed help analysts do their job. In the fall of 2005, they joined forces with C.I.A. wiki experts to build a prototype of something called Intellipedia, a wiki that any intelligence employee with classified clearance could read and contribute to.To kick-start the content, C.I.A. analysts seeded it with hundreds of articles from nonclassified documents like the C.I.A. World Fact Book. In April, they sent out e-mail to other analysts inviting them to contribute, and sat back to see what happened.

Yet Intellipedia also courts the many dangers of wikis — including the possibility of error.

The blog seemed like an awfully modest thing tome. But Meyerrose insists that the future of spying will be revolutionized as much by these small-bore projects as by billion-dollar high-tech systems.Indeed, he says that overly ambitious projects often result in expensive disasters, the way the F.B.I.’s $170 million attempt to overhaul its case-handling software died in 2005 after the software became so complex that the F.B.I. despaired of ever fixing the bugs and shelved it. In contrast, the blog software took only a day or two to get running. “We need to think big,start small and scale fast,” Meyerrose said

There was never a tipping point — “never a moment when two people who never knew each other could begin discussing something,” as Clay Shirky, a professor at New York University who was hired to consult on the project, explained to me. For the intelligence agencies to benefit from “social software,” he said, they need to persuade thousands of employees to begin blogging and creating wikis all at once. And that requires a cultural sea change: persuading analysts, who for years have survived by holding their cards tightly to their chests, to begin openly showing their hands online.

The premise of spy-blogging is that a million connected amateurs will always be smarter than a few experts collected in an elite star chamber; that Wikipedia will always move more quickly than the Encyclopedia Britannica; that the country’s thousand-odd political bloggers will always spot news trends more quickly than slow-moving journalists in the mainstream media.
For all the complaints about hardware, the challenges are only in part about technology. They are also about political will and institutional culture — and whether the spy agencies can be persuaded to change.

Today’s spies exist in an age of constant information exchange, in which everyday citizens swap news, dial up satellite pictures of their houses and collaborate ondistant Web sites with strangers. As John Arquilla told me, if the spies do not join the rest of the world, they risk growing to resemble the rigid, unchanging bureaucracy that they once confronted during the cold war.“Fifteen years ago we were fighting the Soviet Union,”he said. “Who knew it would be replicated today in the intelligence community?”

My comments

First, numerous posts advocating use of web-2 technology, web logs, wikis, etc. are on the site of W. David Stephenson on his Homeland Security site. (see links in this weblog or click here. ) See particularly: Fostering emergent behavior by a networked homeland security strategy: chaos or community. a talk to the International Conference on Complex Systems in June 26, 2006.

Even in 2002, at Infowarcon, Stephenson was sounding this message


These are all reflections of obsolete thinking:

* creating linear, hierarchical practices

* working in isolation

* and devaluing the insights of those from outside our organization or who are low on the organization chart.

Instead, our response to terrorism must be marked by three diametrically opposite characteristics.

First,
we must think cyclically. We paid a terrible price for outmoded procedures that forced people with critical information to route it through a ponderous chain of command designed more to weed out information than speed critical knowledge to everyone who needed it ASAP. So much of the terrorist threat is so unprecedented, so alien to our traditional approaches, that we must instead act quickly, then revise procedures on the fly based on immediate feedback.

Second,
we must link everything. Agencies that have guarded their proprietaryinformation and prerogatives instead of sharing it are intolerable.

Finally,
and most important, we must empower individuals -- in fact, every individual. Preventing and/or responding to terrorist attacks is too great a challenge for government by itself: it must be everyone's job.


He has many more posts indexed on his site that are worth reading.


On my own weblogs, the original "Reticula: weblogs, wikis, and public health", currently renamed "Systems Thinking in Public Health" has a number of posts on this topic, as does this current "Prespectives in Public Health" at http://newbricks.blogspot.com.

I have a somewhat stronger thesis than even Meyerrose or Stephenson, namely, that what we are looking at here is not data fusion but cognition fusion. The point isn't to get some abstract data structure into a particular shape, but to get the cognitive perception process into a particular flow. This is a form of "aperture synthesis", made famous in radio astronomy, where many small radio telescopes could be mathematically merged into one huge virtual receiver with far better resolution than any dish.

This is a brain model, by the way. The brain, after all, has no "master neuron" to which all other neurons report. Human vision does have specialized systems to compute texture, to find straight lines, to connect the dots in aspects of images that vary coherently, but these do not feed into any master center where they are combined and reviewed by the expert neuron -- there is no expert neuron. There is no master center. The findings of each subsystem are shared with all other subsystems in a rapid-fire continuous feedback loop, and the "picture" of what is out there "emerges" collectively.

This model of vision or governance, without any "top person" or "CEO" or "president" or "Director", flies in the face of our machine-age based intuition, unless you've been studying how human vision works.

Posts on the subject:
on aperture synthesis: Houston, we have another problem (Nov 7, 2006, originallyposted Feb 17, 2006 here.)

Blogosphere as Synthetic Social Vision System (Oct 10, 2005)

Seeing Large ideas through small keyholes (Oct 11, 2005)

My weblog: Might as well be alive on meta-life organisms and multilevel architectures.

Positive Organizational Scholarship - making the impossible possible (U of Michigan, Kim Cameron) - getting people at DOE to work together that everyone said couldn't be done.

High reliability organizations

Threat and Error Management (aviation lessons)

US Army Leadership Field Manual FM22-100 (where the doctrine of "integrity" and breaking the top-down information mentality is incorporated into learning organization practices.)





photo by genista.

Sloan on religion and medicine


Richard Sloan had an op-ed piece "Doctors aren't chaplains" in the LA Times today. Here's the gist of it:


The misguided effort to meld religion and medicine. By Richard P. Sloan
RICHARD P. SLOAN, director of the behavioral medical program at Columbia University Medical Center and the New York State Psychiatric Institute, is the author of "Blind Faith: The Unholy Alliance of Religion and Medicine

December 2, 2006

HOW WOULD you like your doctor, at your next examination, to ask not only about your diet and symptoms but about your spiritual life?

... A concerted effort is underway to make religious practices part of clinical medicine. About two-thirds of U.S. medical schools now offer some form of training on the role of religion and spirituality in medicine, according to Dr. Harold Koenig of Duke University....

But before organized medicine decides that religion has any value in physical healing, several things ought to be considered. First, the scientific evidence supposedly linking religious practices with better health is shockingly weak ...Most research studies that claim to show how religious involvement is associated with better health fail to rule out other factors that might account for the relationship.

We all agree, for instance, that there is a real connection between lung cancer and carrying a cigarette lighter in your pocket, but no one thinks that the lighter causes cancer. The lighter is a marker of another factor — smoking — that has been scientifically proved to cause the cancer.

In precisely the same way, religious practices are likely to be markers of some other factor — for example, social support from family, friends or the community or, perhaps, the absence of behavioral risk factors — that may lower the risk of disease...

The effort to link health and religion has other problems as well. For one thing, doctors already have so little time in their interactions with patients that they routinely fail to follow established guidelines for preventive care and for treatment of chronic disease. If, in the future, physicians spend their limited time with patients engaging in spiritual inquiries, they will have even less time to address depression, smoking cessation, weight control or diabetes self-care — factors that are demonstrably related to disease and an increased risk of mortality.

More problematic still is the actual effect on patients when physicians abuse the privileged authority ...

Perhaps most important of all, efforts to connect religion and medical practice are bad for religion itself. Bringing religion to the examining table subjects it to the laws of science, stripping away all elements of transcendence.
... These are matters for patients, their families and the ordained clergy.

Sloan has published a number of papers and op-ed pieces, in addition to his book. Here's a more recent one:

Religious attendance as a predictor of survival in the EPESE cohorts, Emilia Bagiella, Victor Hong, and Richard P. Sloan, Intl J of Epid 2005;34(2):443-451

Results Our analyses show that after controlling for important prognostic factors, frequent religious attendance was associated with increased survival in the entire cohort [risk ratio (RR) = 0.78, 95% Confidence interval (CI) 0.70–0.88]. However, stratified analyses show that this association exists for only two of the four sites.

Conclusions We conclude that the association between religious attendance and survival is not robust and may depend upon unknown confounders and covariates.


And, here's a commentary printed along with that in the same issue of the International Journal of Epidemiology:

Commentary: Understanding religious involvement and mortality risk in the United States: comment on Bagiella, Hong and Sloan, Intl. J. of Epid 2005;34(2):452-3 , Robert A. Hummer

Population Research Center and Department of Sociology, University of Texas at Austin, TX, USA. E-mail: rhummer@prc.utexas.edu

There are a number of excellent classic and contemporary works conceptualizing religious attendance as a social phenomena, detailing measures of religion and what they mean, and laying out the behavioural, psychological, social, and health mechanisms by which religious involvement might work to influence mortality.5–10 None of this literature is referenced, nor did it have any impact on what BHS apparently thought about religious attendance, the religion-mortality relationship, or the possible confounders or mediators of this relationship. As a result, their interpretation of the findings and conclusions can be seriously questioned.

What must be remembered here is that religious attendance should, indeed, display no association with mortality if the complete set of confounding and mediating variables that drive the overall relationship are included in the statistical models...

Third, if the intent of the BHS study is to aid in their well-publicized efforts to keep religious influences out of the practice of medicine, at least based on findings like their own or well-received studies in the religion–mortality area, I am in agreement. A recently published review by myself and several of my colleagues reflects such sentiment.11 Based on findings in the religious attendance–mortality literature, implications for the practice of health care and medicine are limited. Other portions of the religion–health literature—that deal much more directly with religion's possible impacts within clinical settings and with which I am much less involved or an expert on—would seem to be much more relevant in terms of possible implications for health care and medical practice. At the same time, the work by BHS in this issue, as well as related religion–mortality studies within this literature, absolutely beg for a greater understanding of the population-based relationship between religious involvement and mortality for a number of reasons, most importantly including: (i) the development of better social and epidemiological theories of health and mortality; (ii) the better understanding of how demographic and social contexts have impacts on health and mortality patterns.

In conclusion, the BHS article is interesting because it comes from outspoken critics in this area of study, but includes interpretations of the data and conclusions that seem to be based on: (i) a lack of understanding of religious attendance as a social phenomena in the United States; (ii) no theoretical guidance; (iii) questionable interpretations of what their regression coefficients might mean; (iv) little concern for how contexts are important for mortality patterns at the population level; and (v) an agenda that seems to be based on keeping religion out of medicine and health care but is trying to do so using social science and social epidemiology research findings that do not really touch upon religion as an aspect of medical or health care. This fascinating area of scientific inquiry deserves better treatment. It is time to put aside other agendas and work towards scientifically better understanding, with appropriate theoretical guidance, why religious involvement seems to have a beneficial association with mortality risk in the United States. [emphasis added]


5 Durkheim E. Suicide: A Study in Sociology. New York: Free Press, [1897] 1951.

6 Ellison CE, Levin JS. The religion-health connection: evidence, theory and future directions. Health Educ Behav 1998; 25:700–20.[Abstract]

7 Koenig HG, McCullough ME, Larson DB. Handbook of Religion and Health. Oxford: Oxford University Press, 2001.

8 Idler EL, Musick MA, Ellison CG et al. Measuring multiple dimensions of religion and spirituality for health research. Res Aging 2003; 25:327–65.[Abstract]

9 Waite LJ, Lehrer EL. The benefits from marriage and religion in the United States: a comparative analysis. Popul Dev Rev 2003; 29:255–76.[CrossRef][ISI]

10 Musick MA, House JS, Williams DR. Attendance at religious services and mortality in a national sample. J Health Soc Behav 2004; 45:198–213.[ISI][Medline]

11 Hummer RA, Ellison CG, Rogers RG, Moulton BE, Romero RR. Religious involvement and adult mortality in the United States: review and perspective. Sout Med J 2004; 97:1223–30.[CrossRef][ISI]


I agree with Robert Hummer's critique on this issue. When we have religious groups, such as the Church of Jesus Christ of Latter Day Saints (mormons) with an undisputed well-document life expectancy almost 10 years longer than the average US resident, it's both hard and irresponsible to not investigate this question further.

Is Sloan correct that religious attendance is really just a proxy for something deeper? Sure. Is the fact that smoking and alcohol are prohibited by that religion related to this mortality rate? Certainly. Is that's all that's going on? Science doesn't actually know yet.

But if we're spending $100,000 to keep people alive another month in hospitals, you'd think we, collectively, would find it a good investment to put a billion dollars into studying this question correctly, instead of simply complaining that prior studies had weaknesses. After all, it was only a decade ago that organized medicine was willing to recognize that there was a "mind-body" connection, and then only when they could see it on the MRI images.

So, yes, there are many ill-conceived, anecdotal, poorly done "studies" out there. Let's fix that situation by having some much better studies, not by dismissing the question.

Unfortunately, rationality is not what determines how money is spent in the health care arena. If it were, "prevention" would be getting much more than its current 2% of the $1.2 trillion health care bill in the USA today. Prevention is far more cost-effective than heroic repair, but far less glamorous, and far less profitable to the "provider" industry.

It is somewhat paradoxical, but while physicians as individuals are striving to repair and heal patients and maintain good health, the health-care industry as a whole would shut down and die if every person suddenly got well and stayed well. Perhaps that has something to do with why preventive care is so low on the national agenda. Still, it's like not wanting to pay to fix the roof, but being perfectly willing to pay to replace the ceiling and rain-soaked furniture every year.

There are unstated assumptions and broken mental models in the "organized medicine" community regarding the whole area of "public health." It is as important to address these "religiously" held misconceptions and biases and mental models among scientists and doctors as it is to address misconceptions among the various religious groups.



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The importance of social relationships


On the importance of relationships in the successful outcomes any kind of planning:

1) For a human to sustain peak performance, it is not enough to engage the brain; we have to engage the heart.

2) We're very social animals, always watching each other for clues; to sustain a value, we need to see constant reaffirmation from others that it is still a value today.

3) We are each other's context, and have to proactively make an effort daily to give that reaffirmation of our shared values and positive feedback/encouragement for the right thing, not just criticism of the wrong thing.

4) Sustaining that shared spirit is what makes the daily pain tolerable; to paraphrase old wisdom: the spirit can survive any illness, but a broken spirit - who can bear?

5) The side-conversation of any "business" decision has to be a human conversation that says: "We share a goal, we share these values. I really like you. Now, what was it we were arguing over and deciding?"

6) If it doesn't have a spirit, create one; if it has a Spirit, treat that as if it were a living being, with its own "health" and "fitness," and make sure that there's a program to keep it healthy.

7) Beware of solutions based on technology or "systems" that neglect compassion. Compassion is the strongest suit there is, the strength to build on - "He ain't heavy, Father, he's my brother."

The "caring" in "health care" is what makes it work. Not caring will kill any business model, cold. We don't build cars. We don't entertain. We care about people and do something about it. And that's what defines us and gets us up in the morning and holds us up 36 hours later.

8) Spiritual issues (above) have a dramatic impact on the bottom line, clinically and financially.

I see this daily in software design and performance outcomes our IT shop produces, something that at first looks 100% technical. People who care build things that survive. People who don't care build things that look similar but turn out to be a waste of time.

A story is told of two stone-masons working on a huge church in Europe, one with great work and one with sloppy work that needed to be torn down and redone. When asked what they were doing, the poor one said: "I'm building a wall." The other said: "I'm building a cathedral." The spiritual issue matters so much it hurts, in ways science doesn't begin to grasp at the moment.

(photo by jarkkoS )






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US Army Leadership Field Manual FM 22-100


Review: In the introduction by Jeffrey A. Krames, Author of What the Best CEO's Know, he states The US Army Leadership Field Manual presents vital information that can help to shape leaders who inspire people, organize actions, develop strategy, and respond to uncertainty with speed and effectiveness."

As a civilian and MBA, I was startled and pleasantly surprised by the new US Army Leadership Field Manual, affectionately known as "FM 22-100." The concepts presented seem to me to be very much in line with all the recent academic papers on best practices in High-Reliablity Organizations and also Positive Organizational Scholarship.

In fact, whether for daily operations in peacetime, or for preparation for the chaos of an actual bioterrorist event, the book, and the approach of a consistent approach based on character and culture, seems indispensible.

Especially since Public Health, industry, and the military will need to work together in a complete catastrophic event, whether manmade or natural, it would be a great idea to all be on the same wavelength.The Center for Army Leadership has published just such a "wavelength" that appears to me to be suitable for public health, private health centers, private industry, and the US Army.

The burden now, I'd suggest, is for public health leadership to either accept this framework and join in advocating it, or to use it as a benchmarking standard, and evolve something at least that good but fine-tuned to the specific situation and language.

The book is not filled with images of "Rambo", recommendations of a "Kill, kill, kill!" mentality, or other short-sighted violence. In fact, the book notes that the mission of the Army is to resolve any war they are called on to fight in such a way as to build a basis for a sustainable peace afterwards. That approach is far more enlightened than many civilian approaches.

The focus of the book is on a unified, top-to-bottom leadership doctrine that is designed and tested to work in practice, with real people not superheroes, under rapidly changing conditions and great uncertainty about what is going on - a situation US businesses increasingly find familiar.

The surprising central theme is that the crucial element is not technology, or command and control systems, but "how Army values form the basis of character."The McGraw Hill book can be purchased for $15 at Borders or $20 at Amazon here, and viewed in a regretably ugly format on-line as html pages here, if you have a low-speed connection, since the entire manual in pdf form can be downloaded for no charge (it's 9.5 Megabytes.)

The Center for Army Leadership has created a book that is consistently approachable, accessible, practical, and grounded in examples. It is easy and pleasant to read and free of academic or military jargon. I highly recommend it.

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Friday, December 01, 2006

Blog blogs blogging


From Wired


It's the idea that just won't die: A scientific experiment to track the viral spread of a "meme" -- a contagious quanta of thought -- has become so popular that it's creator has had trouble tracking it.

The experiment being conducted by comparative literature graduate student Scott Eric Kaufman was intended to measure how quickly a simple idea would jump between blogs covering different academic disciplines.

The post languished on his site for a few hours and then got picked up by a colleague's blog. After that, the meme took flight in a way that surprised the literature student: Almost 50 blogs, including a number of science forums, linked back to the post in less than three days. "I didn't realize this many people would be interested," said Kaufman, "which is itself of interest."

(photo credit: zachstern at flickr )


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Radioactivity in cigarette smoke


New York Times Op-Ed piece on polonium in cigarettes

Puffing on Polonium

December 1, 2006

By ROBERT N. PROCTOR

WHEN the former K.G.B. agent Alexander V. Litvinenko was found to have been poisoned by radioactive polonium 210 last week, there was one group that must have been particularly horrified: the tobacco industry.

The industry has been aware at least since the 1960s that cigarettes contain significant levels of polonium.

Subscribers to NYTimes, click here for the rest of the article.

Robert N. Proctor is a professor of the history of science at Stanford University.

==========================

See new figures on smoking's toll in WHO's latest projections for 2015 and 2030 from Public Library of Science Medicine. According to the World Health Organization:

"But, even given the rise in HIV/AIDS deaths, the new projections predict that more people will die of tobacco-related disease than of HIV/AIDS in 2015."

Citation: Mathers CD, Loncar D (2006) Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 3(11): e442. doi:10.1371/journal.pmed.0030442

(photo credit: digital_trash on flickr)


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Thursday, November 30, 2006

One Laptop per Child - grid computing for the poor

Negroponte's dream project for $100 computers for every poor child in developing nations, "One Laptop per Child", has a critical vision beyond that perceived in the popular press.

The New York Times covered this yesterday (november 30,2006) in an article "For $150, Third world laptop stirs a Big Debate" by John Markoff. Compare to "Microsoft would put Poor Online by Cellphone", also by John Markoff, Jan 30, 2006.

According to Markoff's article yesterday "Five countries — Argentina, Brazil, Libya, Nigeria and Thailand — have made tentative commitments to put the computers into the hands of millions of students, with production in Taiwan expected to begin by mid-2007." Much of the rest of the article deals with pricing, technology, and competing views about the impact of this computer on education.

That misses the most important aspect of this, in my mind, which Markoff mentions near the end of the piece:

One factor setting the project apart from earlier efforts to create inexpensive computers for education is the inclusion of a wireless network capability in each machine.

The project leaders say they will employ a variety of methods for connecting to the Internet, depending on local conditions. In some countries, like Libya, satellite downlinks will be used. In others, like Nigeria, the existing cellular data network will provide connections, and in some places specially designed long-range Wi-Fi antennas will extend the wireless Internet to rural areas.

When students take their computers home after school, each machine will stay connected wirelessly to its neighbors in a self-assembling “mesh” at ranges up to a third of a mile. In the process each computer can potentially become an Internet repeater, allowing the Internet to flow out into communities that have not previously had access to it.

“The soldiers inside this Trojan horse are children with laptops,” said Walter Bender, a computer researcher who served as director of the Media Laboratory after Mr. Negroponte and now heads software development for the laptop project.

Each machine will come with a simple mechanism for recharging itself when a standard power outlet is not available. The designers experimented with a crank, but eventually discarded that idea because it seemed too fragile. Now they have settled on several alternatives, including a foot pedal as well as a hand-pulled device that works like a salad spinner....

“They should buy Dell’s $499 laptop for now,” he said. “Ours is really designed for developing nations — dusty, dirty, no or unreliable power and so on.”

In his two decades as director of the Media Laboratory, Mr. Negroponte often faced criticism because the institution’s impressive demonstrations of technology only occasionally led to commercial applications.

So, a few observations and comments

First, and most importantly, this technology should be immediately incorporated into Homeland Security and emergency preparedness infrastructure. It is astounding that, during Katrina, because of the damage, for the most part the people in the Superdome, and elsewhere, were simply cut off from communications with the outside world.

This technology demonstrates that we don't need all that infrastructure. We don't need a power grid, or satellites, or cell phones, in an emergency, if we have hardware that assembles its own network and passes messages from one user to another. This won't handle normal computing, but it sure would handle emergency traffic better than occurred during Katrina.

Stephenson points out the need for this type of infrastructure repeatedly. Yesterday he posted "Communications Strategy Emphasizes Reslience" . He has a marvelous cache of his best posts on Homeland Security and the first of those, "Why doesn't DHS have a netwars strategy to avoid future debacles?" (June 26, 2006) makes these points:


Fostering emergent behavior by a networked homeland security strategy: chaos or community?

By W. David Stephenson International Conference on Complex Systems June 26, 2006

This presentation will examine the possibility of extending the netwar concept to domestic homeland security. In particular, the author's thesis is that a combination of two factors that have only become widespread during the past 15 years:

  • the development and widespread adoption of networked communications technologies and applications on one hand
  • and the growing body of scientific understanding of emergent behavior on the other,
present a new opportunity that, to my knowledge, has not been formally analyzed in this regard: using networked communications technologies that were unavailable as recently as when Arquilla and Ronfeldt wrote "The Advent of Netwar" only a decade ago, to not just make emergent behavior possible, but actually foster it. To the author's knowledge, this is an option that has not received any serious scrutiny by the Department of Homeland Security, let alone consideration of it as a basic operating principle.

The presentation will conclude with an example providing a sense of how a networked homeland security strategy designed specifically to encourage emergent behavior might be structured and function.

...

individuals participating in emergent behavior produce results that are far greater than the sum of their parts. In the case of Katrina, still others spontaneously came together to craft imaginative Google Map mashups to allow identification of homes in New Orleans, or to create unified databases of those needing assistance.

So we know that emergent behavior is possible even under the trying circumstances of a terrorist attack or a natural disaster.

... Equally important but less understood by decision makers, unlike landline phones or the broadcast media, these devices are themselves increasing networked, self-organizing, and self-healing. In many cases, such as mesh networks that were originally developed for the military in battlefield conditions and now are being used by civilians, the networks don't require any kind of external networking: simply turn them on and the network self organizes.

I am convinced that such a networked homeland security strategy is feasible today, using existing technology and requiring much less time to create and deploy than some of the costly, dedicated emergency communications systems government is creating. Equally important, by facilitating those three qualities needed in a crisis: flexibility, robustness, and self-organizing, it could transform the general public from hopeless victims, waiting for aid that may never come, into self-reliant components of the overall response. To paraphrase Dr. King, which will it be, chaos, or community? [emphasis added]

So why isn't a networked homeland security strategy under consideration?

(photo by GustavoG at Flickr)

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Wednesday, November 29, 2006

Is short-sighted greed the best we can manage?



Emergent solutions are good, but some are way better than others. This post is an academic musing on why that is and what solutions it suggests to many organizational problems.

The term emergence is used to describe large-scale results that aren't built in by the local rules, but that end up happening as a downstream effect of those rules being applied locally millions or billions of times. A tornado is an example.

Emergent solutions can be very powerful, and much more adaptive than consciously programmed solutions, as computer scientists are revealing.

To a large extent, the theoretical underpinnings of what economists call "free markets" are based on emergence, on "the invisible hand of Adam Smith", with the explicit assumption that billions of local transactions made by self-serving, self-centered, short-sighted individuals will add up to the best possible outcome.

Given the complexity of modern problems, it seems clear that "planned economies" or top-down driven organizations of any type are becoming increasingly extinct and incapable of responding or adapting to the speed of change around us. The questions are less "who" should be "at the top" as to whether there needs to be "a top", and, if so, what the role is of "the top."

It is clear that the role of the top management is not to know all things and have all wisdom. The old "Theory X" is being replaced by "Theory Y", although not without bloodshed. In large organizations, in hospitals, in the US Army, it is increasingly clear that knowledge of what's going on is increasingly at the front lines or the "bottom" of the organization, not at the top.

Still, we have only replicated on a larger scale the same problem of global versus local. Now the problem in large organizations is "silos", multiple internal departments that, gasp, try to follow short-sighted, self-centered rules or algorithms. It is clear to many in leadership that this type of operation has very clear limits.

So, while emergent solutions may be far better than planned ones, there may also be different kinds of emergent solutions, some of which are far better than others. How do we proceed?

One theme that is visible in corporations, or universities, is the constant cyclical battle between "centralization" and 'decentralization" of services, such as Information Technology (IT) which in universities tends to be about a 7 year pendulum swing from one "side'" to the "other."

Advance accounting systems have been invented that try to "make the global local" by altering the perceived price of goods internally, so that the short-sighted, self-centered ("greedy") decision makers will result, through emergence, in globally optimal solutions. That hasn't worked very well.

So, we have managed to get the planet to this point, but as expansion space runs out globally, we have on many scales the problems of silos - competing groups that each want to try to reshape the world in their own image, and that's resulted in figurative and literal wars.

What to do?

"Homogenization" has been proposed - the idea that, if everyone were like us, it would work. The problem is that the specialization evolved for a reason, and serves a purpose. There is great value for the species and long-term in diversity.

So, we need something that does both at once - a mystical unification of purposes on a global sense, while leaving diversity on a local scene. Are such solutions conceptually possible? Have we ever seen any examples? And how would we know?

One metric is looking at what class of difficulty cannot be solved by a particular set of rules, even used emergently. For example, the "greedy algorithm" solutions may not be able to solve problems such as "tragedy of the commons," where each actor would have to behave a little less selfishly locally in order to achieve a longer-term mutual benefit.

That problem, however, is precisely the problem we are faced with on all sides. The development of, say, an Electronic Health Record (EHR) requires that each department, with its own definitions of everything, will have to yield a little bit and take the cost hit of changing to a set of common definitions of terms, a change that, in the short run, in any one budget year, will be a pure cost with no tangible benefit. Further, much of the EHR seeks to achieve collaboration via dull-witted, least-common-denominator homogenization, precisely the evil that departments evolved specializations and specialized vocabularies to overcome.

So, if "overcoming silos" means everyone has to change to match silo X, you can forget it, unless we're silo X, in which case we agree.

What we need is more of a dynamic, almost fractal EHR format where the complexities of specialized areas are retained within the silo, and accessible within that area as the local working language and reference frame, but are ALSO summarized, and simplified, to something that makes sense, albeit with far less precision, and is shareable outside the silo.

The key issue that has to be solved is that the detailed view and the (over)simplified global view have to be linked, under the covers, so that if one changes, the other changes as well.

For mathematicians, it is similar to a metric where data tensors have rank N at each department, but are represented as reduced rank tensors at larger scale views. The internal complexity has to evaporate gracefully, leaving just the validly simplified essence at each higher level of scale. This is, of course, what we wish any management reporting system would do, but seldom does. In practice, there is over-simplification and distortion at each management reporting level, so that what makes it to the top is close to useless.

Emergent organizational solutions are required, because there is no reshuffling of reporting relationships that can fix that problem, and no restaffing plan with new competencies that will resolve it. What FEMA delivered in Kartrina is what top-down organizations are capable of, period. It doesn't get any better than that. The whole design is broken, the architecture doesn't work, the algorithm is too weak for the task.

So, because of bandwidth, speed, agility, response-time, adaptiveness, and robustness to broken units (i.e., corruption), decision making in organizations has to be pushed out and decentralized BUT, and this is a big but, it still has to have some kind of over-arching central unity and coherence, a coherence that doesn't come from billions of short-sighted, self-centered decisions.

The solution, it seems to me, comes from looking at what I've called the four levels of decision making that networks of mutually interacting feedback-controlled dynamic systems involve. They can battle over data, the first level. They can disagree on the model or framework in which the world is interpreted, the second level. They can disagree on their temporarily assigned goals and interests the third level. And they can disagree on their identity, the fourth level.

Safety cultures and highly-reliable organizations recognize that they have to get above disputing facts to challenging frameworks and mental models. So far so good. Books like "Getting to Yes" describe how to get past locked in "positions" and move to finding underlying common "Interests", which address the third level.

But, this fourth level I suggest is the critical one. For humans, there is a flexibility in identity itself. Some call this a feature, some call it a bug. A person can change, almost in an instant, from thinking of "me" to thinking of a larger "us", whether driven by protection of children, of family, of culture, of a nation in a patriotic effort, or defending the species against alien insect invaders. People can and do willingly sacrifice their body and life for a larger "us" that, at that moment, is really perceived as "me". This gets into the whole social evolution of altruism question, which I'm aware of but not going into.

The relevance is that the peak solutions for innovative, reliable, powerful groups of people require, unambigously, that the people be capable, at least at times, of working as one, of each person actually perceiving that the team as a whole is them, and the interests of the whole group are their own interests, so that it is no big deal, EVEN IF DRIVEN BY GREEDY SHORTSIGHTEDNESS, to give up some asset or resource or take some pain for a different protoplasmic unit (person) who is, at that moment, perceived to be as much me as my own hand or foot is.

This is the state of activity that Professor Kim Cameron and Positive Organizational Scholarshiop at the University of MIchigan are studying. This is a mode of operation that actually works in practice, and has saved billions of dollars on the bottom line when it hits critical mass and takes over.

We need to learn more about that. If there is a way to deal with silos, and to get what the Institute of Medicine calls "microsystems" to work together, it needs something like that, supported with the sort of fractal-tensor IT structure I also touch on above for sharing "data", especially data that are context-dependent, where we need to retain not only the data, but also the context, and where transmitting data involves transforming it validly to account for the different contexts of the viewer and the submitter of the data. We need a "context processor" not just a "data processing" solution, at a minimum.

What we really need is the whole four levels, a data processor, a context-processor, a goal-processor, and an identity processor. Then we can overcome silos without requiring homogenization, let people work in familiar worlds, but still communcate between silos and achieve not only collaboration, but actual ability to overcome "tragedy of the commons" level problems that current systems and approaches cannot.

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Tuesday, November 28, 2006

New York State hospital closings - report

You can download the final report from the New York State Commission on Health Care in the 21st Century here.
http://www.nyhealthcarecommission.org/

New York Times
November 28 2006

A long-awaited plan to shrink New York State’s hospital industry landed yesterday with the force of an earthquake, with proposals that could effectively eliminate 20 or more hospitals and thousands of jobs, and force dozens of other hospitals to shrink, merge or take on new roles.

The recommendations by the Commission on Health Care Facilities in the 21st Century, go far beyond the 9 hospital closures and downsizings that state officials reported late Monday, after being briefed by the commission.

Monday, November 27, 2006

Bring back Saddam Hussein?

The Army's move to expand their thinking and actions to include development of order, not just the removal of the old order, seems to be a good thing.

We need to learn how to transition from one order to a better order without chaos breaking out in the middle. This is getting way too expensive and risky.

Lack of it has led to more than the removal of Donald Rumsfield. Now, we have people in the LA Times actively suggesting the return of Saddam Hussein to power.

Only dealing with part of the problem is increasingly looking like thousands or hundreds of thousands of people, depending on how you count, have sacrificed in vain. We really owe it to them to learn the lessons this is trying to teach us and give meaning to their sacrifice.


See one of the most viewed opinion pieces in the LA Times:

Johnathan Chait: Bring back Saddam Hussein

LA Times

Nov 26, 2006

Excerpt:

------------------------

At the outset of the war, I had no high hopes for Iraqi democracy, but I paid no attention to the possibility that the Iraqis would end up with a worse government than the one they had. It turns out, however, that there is something more awful than totalitarianism, and that is endless chaos and civil war.

know why restoring a brutal tyrant to power is a bad idea. Somebody explain to me why it's worse than all the others.

------------------------

Actually, while it dominates the headlines today, Iraq is just one example of a larger class of problems that we face as a planet. Charles Perrow, in his book Normal Accidents- Living with High-Risk Technologies, make several key points.

  • We keep making the world riskier by our efforts to make it safer, on many fronts. When we master building 100 story buildings, someone says great, let's build a 200 story one. When we get cars that are safe at 60 MPH, people go, great, let's go 85 mph now.
  • This problem is everywhere, and it will just keep on getting worse.
  • In most cases, the best thing we can do is learn how "safety cultures" work and how "high reliability organizations" function.
  • In some cases, the only thing to do is to back away from that technology and say, "No, we're not organized enough as a species to manage that safely."
  • That last thing is a really unfamiliar and hard thing to do.

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What relates public health and the US Army?


A question came up as to why a weblog on "public health" had postings on the US Army field manuals. Good question - stick around for the answer.

Probably the most common misperception of "public health" is to think that the field is about "health care for poor people." In fact, the field is about whatever is out there that is a health threat to the public. That means looking at people thousands or millions at a time, instead of one at a time in a doctor's office or hospital.

So, Homeland Security issues are part of that perspective. Anything that might lead to or prevent World War III is part of that perspective. Reimbursement rates for doctors or hospitals is part of that. The size of your co-pay for your health benefits at work is part of that.

Operations of the US Army and government decision making, especially in crisis situations is part of that. Why was the FEMA response to hurricane Katrina such a disaster? How will the Red Cross, the Coast Guard, ahd the Natioinal Guard work together? Who's doing what to make that better for the next natural or man-made disaster? Those are part of public health too.

Another major difference between public health and routine health care is that public health is less interested in how to fix the person in the ER with a gunshot wound, and more interested in why so many people with gunshot wounds are showing up lately. Inteventions have very little funding, as "prevention" is notoriously hard to sell to the public, so the researchers are forced to keep looking further and further upstream to find "root-causes' and high-leverage points.

What's clear from the Katrina response is that organizational decision making can neutralize or ruin even large quantities of resources or assets on hand. So, the quality of decision making in crises is fair game.

One thing the US Army has specialized in is being a "learning organization". They spend a great deal of time learning by observing what actually works in practice, and they get a lot of practice. General wide-spread disaster response is way less frequent, thank goodness, but that also means that the feedback loop that generates learning is far less powerful.

In short, if public health doesn't learn from the Army's lessons what it takes to respond to a crisis under fire and chaotic conditions, then those lessons will be learned the hard way and millions of people will suffer with more Katrina-type screwups.

In fact, there is some evidence that the whole concept of trying to concentrate decision-making "at the top" of a corporation or the civilian government is a bad idea in general. The visibility of actual reality decreases with each level of administration. There are serious bandwidth problems meaning, in a crisis, there are simply not enough people at the top to make all the necessary decisions if they wanted to and were 100% competent and motivated. There are massive priority problems as people at the top will be instantly preoccupied with "very big questions" and shut off their phones to "lesser questions", such as, oh, whether one particular state or city is at risk.

In short, a case can be made that the Katrina response by FEMA was not an aberration, but is totally representative of any response by any government that tries to concentrate all decision-making at the top, period, regardless who is in power at the time. The problem is a "systems problem", not a people problem. It won't be fixed by replacing Michael Brown in FEMA, or some general in Iraq.

In the human body, for example, touch typing on a keyboard would be impossible if every decision had to be checked with the brain. It takes about 100 milliseconds for a nerve impulse to make it from the finger up to the brain and back, whereas keys have to be struck in the right order as short as 15 milliseconds apart. There is no choice - much of the decision making has to be delegated to the hand.

This is the sort of life-science question that crosses all scales. How do organizations and organisms push and delegate decision-making down to the front, while retaining central control of the mission, and all the while remaining flexible and open to news that the situation out there at the front, on the ground, at the fingertips is not the one everyone thought it was.

The US Army is the best example around of a group that is trying to learn what is actually connected to what, and how it works, based on both academic theory and actual practice.
We can learn a lot from it that can be applied to public health. We better - we'll need it.



Photo by Giampaolo Macorig from Flickr.







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New York hospitals to close - drastic restructuring

Another item of note from the New York Times

No Clues Yet as Health Industry Awaits Report on Downsizing

November 27, 2006


Richard Perez-Pena

An economic shock wave, years in the making, is expected to hit New York this week. It could alter or eliminate tens of thousands of jobs, and change the way millions of people receive health care.

Yet the moment will catch most New Yorkers by surprise, and even those who know of it and care deeply have little real idea what to expect.

On Tuesday, a commission created by state lawmakers will release a plan for downsizing the hospital and nursing home industries across the state. Under the law that created the panel, the recommendations will become law unless the governor or the Legislature acts in December to reject the entire plan — it cannot approve some pieces and not others.

It goes on

Officials hope that downsizing will shore up the surviving hospitals by leaving them with more patients and putting them in a stronger position to bargain with health insurance companies. They predict that economically sound hospitals will invest more in computer systems — an area where New York lags behind much of the country — and other innovations that will make them more efficient.

David Sandman, the commission’s executive director, said he was sympathetic, but he disagreed. Last week, a published report speculated as to which hospitals might be closed, prompting panicked responses from their executives and employees.

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